The knee is one of the most delicate parts of the body for athletes. For cyclists, this opens up a whole new world of challenges and situations that can lead to more or less serious injuries. Two of these are certainly: falls and incorrect riding positions. Underestimating or rushing to get back on the bike after a knee injury are two dynamics that can cause serious problems in the future.
In one of ours interview, Davide Ballerini he said: «After the fall, I did 20 days without a bike before. I thought it was a small thing, but it turned out not to be the case. After the break I started again and I always had a pain in my knee».
To delve deeper into the cases and pitfalls that cyclists may encounter, we relied on the expert opinion of Marco Corzani, MD, knee surgery specialist, ankle and foot at the Fisioradi Medical Center.
Are knee injuries in cyclists mostly caused by falls?
In sports traumatology, in reality, they are more than anything else caused by distortion, for example in football, volleyball, basketball they are due to changes in direction, when the knee is in torsion and flexion. The worst cases for the joint are: Direct impact traumas are less frequent, they are generally related more to road accidents, traumas from falls for example, on a bicycle, motorcycle and situations of this type.
Taking Ballerini's case as an example, what kind of injury is likely to occur?
A fall with impact on the knee, therefore on the patella, is a little different from sprain injuries. It is necessary to look for damage to the cartilage, which is easily detected with MRI. Impact injuries are due to high energy contact between the patella and the femur. These traumas are like micro fractures in the cartilage and the bone underneath itThey cause swelling, pain, and functional impairment. So the knee is no longer what it used to be.
How are they treated?
With rest, the joint can be restored to a more or less healthy state within 20 days, depending on the individual case. Unfortunately, healing times must be respected. The bone must be given time to heal. What can be done to help a high-level athlete is to slightly adjust what they can and cannot do. It's important to try to reduce knee flexion and extension, because these tend to irritate the affected area. You should work more on the quadriceps, for example, with leg extensions to make it easier to get the bike back.
Rest is important. Is it dangerous to start again early, even if you feel good?
Generally yes, in the sense that If we anticipate the times it is a gamble, because there is a risk that if the lesion does not heal properly, the after-effects will persist for a long time.
Can knee pain recur after this type of injury?
No, it doesn't recur because it's related to an acute trauma. What can recur is the symptoms. Because that event may have caused some... cartilage alterations that subsequently create a “wear and tear” problem. If a significant lesion has occurred in the cartilage, which has not been treated with due care, and the timing is rushed, this lesion in the long run causes early osteoarthritis of the patellofemoral joint.
Is surgery ever performed in these cases?
Yes, there are various levels of treatments. The first is hyaluronic acid, a mild anti-inflammatory, but above all it is a gel that nourishes the cartilage and makes it more trophic., that is, more voluminous and prepares them better for work. It acts as a lubricating oil basically. Subsequently, if we see that at the resonance the trauma is visible with cartilage detachments, in those cases then the treatment becomes surgical.
Does the surgery lengthen recovery time?
Yes. What can be done from a physiotherapy perspective, such as muscle tone control, is much more limited and must also be remodulated, obviously trying not to stop the athlete for a long period.
In your experience, have you had to deal with cyclists who have suffered knee problems, even if they weren't of this type?
Yes, it's interesting because the pathology that affects the cyclist is a bit of a separate chapter of the kneeThe extensor apparatus is composed of the quadriceps, quadriceps tendon, patella, and patellar ligament. These are the cyclist's engine, and the knee is the one that works the most, acting during pedaling. There are many pathologies that cause pain in the anterior area of the knee, as so many structures are involved. During pedaling: The kneecap is a bone that slides over a track repetitively and creates repeated wear over time, which can develop into osteoarthritis in the future. It's important for cyclists to carefully calibrate their saddle height and develop a correct pedaling arc. These are variables that will undoubtedly affect knee health in the future.
An example of possible cases due to this wear and tear?
The technical gesture has an importance in what can then become a problem in the future. For example, those who pedal with the very adducted knees, so very close to each other, is a little more prone to anterior pains such as patellar tendonitis, quadriceps tendonitis, or similar conditions. Those who pedal with the flexed heels, therefore with the ankle too much in dorsiflexion, is more likely to develop problems in the future. So it is It is also important to have a biomechanic and a coach who can correct the technical gesture because the cleaner the movement, the less likely you are to suffer from injuries or pain from overtraining.
So it's not the bike that leads to these situations but an incorrect position or technical gesture?
Exact, It's not the bike itself that hurts, but an incorrect position that can lead to this. Obviously, everything depends on the level of your cycling commitment. Clearly, a cyclist who rides 100 kilometers a week is less exposed than one who rides 200. However, if a cyclist who rides 100 kilometers has poor pedaling technique, they will certainly be more prone to developing problems in the future.
